CLINICAL STUDY
Lower standing systolic blood pressure as a predictor of falls in the elderly: a community-based prospective study
Kazuomi Kario, MD, PhD, FACC, FACP* b,
Jonathan N. Tobin, PhD*  ,
Leslie I. Wolfson, MD ||,
Robert Whipple, MA, RPT ||,
Carol A. Derby, PhD,
Devender Singh, MD,
Paul R. Marantz, MD, MPH and
Sylvia Wassertheil-Smoller, PhD
* Clinical Directors Network, Inc., New York, New York, USA
b The Zena and Michael A. Wiener Cardiovascular Center, Mount Sinai School of Medicine, Bronx, New York, USA
Department of Epidemiology and Social Medicine, Bronx, New York, USA
Department of Neurology, Albert Einstein College of Medicine of Yeshiva University, Bronx, New York, USA
|| Department of Neurology, University of Connecticut Health Center, Farmington, Connecticut, USA
Manuscript received August 23, 2000;
revised manuscript received March 19, 2001,
accepted March 29, 2001.
Reprint requests and correspondence: Dr. Jonathan N. Tobin, Clinical Directors Network, Inc., 54 West 39th Street, 11th Floor, New York, New York 10018
jntobin{at}CDNetwork.org
OBJECTIVES
We investigated prospectively the relationships among falls, physical balance, and standing and supine blood pressure (BP) in elderly persons.
BACKGROUND
Falls occur often and adversely affect the activities of daily living in the elderly; however, their relationship to BP has not been clarified thoroughly.
METHODS
A total of 266 community-dwelling elderly persons age 65 years or over (123 men and 143 women, mean age of 76 years) were selected from among residents of Coop City, Bronx, New York. Balance was evaluated at baseline using computerized dynamic posturography (DPG). During a one-year follow-up, we collected information on subsequent falls on a monthly basis by postcard and telephone follow-up.
RESULTS
One or more falls occurred in 60 subjects (22%) during the one-year follow-up. Women fell more frequently than men (28% vs. 16%, p < 0.03), and fallers were younger than nonfallers. Fallers (n = 60) had lower systolic BP (SBP) levels when compared with nonfallers (n = 206) (128 ± 17 vs. 137 ± 22 mm Hg for standing, p < 0.006; 137 ± 16 vs. 144 ± 22 mm Hg for lying, p < 0.02), whereas diastolic BP was not related to falls. Falls occurred 2.8 times more often in the lower BP subgroup (<140 mm Hg for standing SBP) than in the higher BP subgroup ( 140 mm Hg, p < 0.0003), and gender-related differences were observed (p = 0.006): 3.4 times for women (p < 0.0001) versus 1.9 times for men (p = 0.30). Loss of balance, as detected by DPG, did not predict future falls and was also not associated with baseline BP levels. Multiple logistic regression analysis demonstrated that female gender (relative risk [RR] = 2.1, p = 0.02), history of falls (RR = 2.5, p = 0.008) and lower standing SBP level (RR = 0.78 for 10 mm Hg increase, p = 0.005) were independent predictors of falls during one year of follow-up.
CONCLUSIONS
Lower standing SBP, even within normotensive ranges, was an independent predictor of falls in the community-dwelling elderly. Elderly women with a history of falls and with lower SBP levels should have more attention paid to the prevention of falls and related accidents.
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Abbreviations and Acronyms
| | BP | = blood pressure | | DBP | = diastolic blood pressure | | DPG | = dynamic posturography | | MCT | = Motor Coordination Test | | MRI | = magnetic resonance imaging | | RR | = relative risk | | SBP | = systolic blood pressure | | SHEP | = Systolic Hypertension in the Elderly Project | | SOT | = Sensory Organization Test |
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